Browsing by Author "Castillo Fuenzalida, Luis Benito"

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    Acute effect of dobutamine and amrinone on hemodynamics and splanchnic perfusion in septic shock patients
    (1999) Hernández, P. Glenn; Gigoux Muller, Jorge Alberto; Bugedo Tarraza, Guillermo; Castillo Fuenzalida, Luis Benito; Bruhn Cruz, Alejandro Rodrigo; Tomicic, Vinko; Dagnino Sepúlveda, Jorge Álvaro
    Background: Vasoactive drugs used in the reanimation of septic patients, can modify splanchnic perfusion. Aim: To compare the effects of dobutamine and amrinone on gastric intramucosal pH (pHi), lactate levels and hemodynamics in surgical patients with compensated septic shock. Patients and methods: Fourteen postoperative patients with abdominal sepsis and compensated septic shock (pHi < 7.32 or lactate > 2.5 mmol/l) were studied in a prospective, randomized, unblinded study. Patients were randomized to receive (Group 1, n = 7) dobutamine at 5 micrograms/Kg/min or (Group 2, n = 7) amrinone at 5 micrograms/Kg/min. Hemodynamic data, arterial lactate and pHi were measured before and 30, 60 and 120 minutes after starting drug infusion. Results: Both drugs were associated with a decrease in lactate levels. Dobutamine infusion, but not amrinone, increased gastric pHi, as well as cardiac index and oxygen delivery. Conclusions: An improvement in gastric pHi associated with an increase in oxygen delivery, was observed with dobutamine. Amrinone showed no effect at the fixed, low dose used in the study.
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    An evidence-based resuscitation algorithm applied from the emergency room to the ICU improves survival of severe septic shock
    (2008) Castro López, Ricardo; Regueira Heskia, Tomás; Aguirre Zúniga, Marcia Lorena; Llanos Valdés, Osvaldo Pablo; Bruhn, Alejandro; Bugedo Tarraza, Guillermo; Dougnac Labatut, Alberto; Castillo Fuenzalida, Luis Benito; Andresen Hernández, Max; Hernández P., Glenn
    Background. Septic shock is highly lethal. We recently implemented an algorithm (advanced resuscitation algorithm for septic shock, ARAS 1) with a global survival of 67%, but with a very high mortality (72%) in severe cases [norepinephrine (NE) requirements >0.3 µg/kg/min for mean arterial pressure ≥70 mmHg]. As new therapies with different levels of evidence were proposed [steroids, drotrecogin alpha, high-volume hemofiltration (HVHF)], we incorporated them according to severity (NE requirements; algorithm ARAS-2), and constructed a multidisciplinary team to manage these patients from the emergency room (ER) to the ICU. The aim of this study was to compare the outcome of severe septic shock patients under both protocols. Methods. Adult patients with severe septic shock were enrolled consecutively and managed prospectively with ARAS1 (1999-2001), and ARAS-2 (2002-05). ARAS-2 incorporates HVHF for intractable shock. Results. Thirty-three patients were managed with each protocol, without statistical differences in baseline demographics, APACHE II (22.2 vs 23.8), SOFA (11.4 vs 12.7) and NE peak levels (0.62 vs 0.8 µg/kg/min). The 28-day mortality and epinephrine use were higher with ARAS-1 (72.7% vs 48.5%; 87.9% vs 18.2 %); and low-dose steroids (35.9% vs 72.7%), drotrecogin (0 vs 15 %) and HVHF use (3.0% vs 39.4%) were higher for ARAS-2 (P<0.05 for all). Conclusion. Management of severe septic shock with a multidisciplinary team and an updated protocol (according to the best current evidence), with precise entry criteria for every intervention at different stages of severity, may improve survival in these patients. Multidisciplinary management, rationalization of the use of vasoactives and rescue therapy based on HVHF instead of epinephrine may have contributed to these results. Management of severe septic shock with these kinds of algorithms is feasible and should be encouraged.
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    Cateterización venosa suprahepática en cuatro casos de shock séptico severo
    (2001) Inzunza Pérez, Carlos; Cornu A., M.; Bruhn, Alejandro; Castillo Fuenzalida, Luis Benito; Bugedo Tarraza, Guillermo; Acuña C., D.; Medeiros U., S.; Hernández P., Glenn
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    Experiencia preliminar del tratamiento con dexmedetomidina del estado confusional e hiperadrenergia en la unidad de cuidados intensivos.
    (2002) Romero Patino, Carlos Miguel; Bugedo Tarraza, Guillermo; Bruhn, Alejandro; Mellado T., Patricio; Hernández P., Glenn; Castillo Fuenzalida, Luis Benito
    Delirium (confusion) is an acute, reversible and fluctuating compromise of awareness and cognitive function, a state that can increase morbidity and mortality. We describe four patients with delirium associated with agitation and hyperadrenergic states refractory to haloperidol but responsive to dexmedetomidine.
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    High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock
    (2006) Cornejo, Rodrigo; Downey Concha, Patricio; Castro López, Ricardo; Romero, Carlos; Regueira Heskia, Tomás Emilio; Vega Stieb, Jorge Enrique; Castillo Fuenzalida, Luis Benito; Andresen Hernández, Max Alfonso; Dougnac Labatut, Alberto; Bugedo Tarraza, Guillermo; Hernández Poblete, Glenn Wilson
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    Hipotermia intravascular inducida en el manejo de la hipertensión intracraneana en insuficiencia hepática aguda. Caso clínico
    (2009) Castillo Fuenzalida, Luis Benito; Pérez Ríos, Cristián; Ruiz B., C.; Bugedo Tarraza, Guillermo; Hernández P., Glenn; Martínez Castillo, Jorge; Jarufe Cassis, Nicolás; Pérez Ayuso, Rosa María; Mellado T., Patricio; Domínguez, P.
    Acute liver failure has a mortality rate in excess of 80%. Most deaths are attributed to brain edema with intracranial hypertension and herniation of structures, where ammonium plays a major role in its generation. We report an 18 year-old female with a fulminant hepatic failure caused by virus A infection. The patient developed a profound sopor and required mechanical ventilation. A CT scan showed the presence of brain edema and intracranial hypertension. A Raudemic® catheter was inserted to measure intracranial pressure and brain temperature. Intracranial hypertension became refractory and intravascular hypothermia was started, reducing brain temperature to 33oC. Seventy two hours later, a liver transplantation was performed. After testing graft perfusion, rewarming was started, completing 122 hours of hypothermia at 33oC. The patient was discharged in good conditions after 69 days of hospitalization (Rev Méd Chile 2009; 137: 801-6).
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    Implementation of a norepinephrine-based protocol for management of septic shock: a pilot feasibility study
    (2006) Hernández P., Glenn; Bruhn, Alejandro; Romero Patiño, Carlos; Larrondo Gálvez, Francisco Andrés; De la Fuente Sanhueza, René; Cornejo, Rodrigo; Castillo Fuenzalida, Luis Benito; Bugedo Tarraza, Guillermo
    Background: The subject of the best vasopressor for hemodynamic management of septic shock (SS) is controversial. One of the difficulties in planning such studies is that physicians are reluctant to use one vasopressor exclusively, and there is considerable variation in practice. The aim of this study was to test the feasibility of implementing a single pressor-based algorithm (in this case, norepinephrine [NE]). Methods: A NE-based algorithm was applied prospectively to 100 consecutive SS patients. A formal training program was implemented before starting the protocol and applied to 72 physicians and nurses involved in intensive care unit (ICU) patient care. Compliance, protocol violations, probable adverse effects, and outcome were evaluated on a daily basis by an independent group of fellows and a research nurse. Results: In 100 patients, there were 7,139 hours of algorithm use. Only 13 protocol violations were observed, mostly in the timing of inotropic drugs. Senior staff physicians or busy night shifts accounted for most of these violations. ICU mortality was 33%, which is comparable to that predicted by Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. Adverse events probably related to NE were not observed. Conclusions: The present algorithm, applied after a strict training program, obtained an overall good acceptance and compliance with very few protocol violations in more than 7,000 hours of use. Safety was demonstrated by a global mortality comparable to that predicted by severity scores and absence of specific drugrelated morbidity. The implementation of a single pressor-based algorithm for SS is feasible and safe.
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    Lung computed tomography during a lung recruitment maneuver in patients with acute lung injury
    (2003) Bugedo Tarraza, Guillermo; Bruhn, Alejandro; Hernández P., Glenn; Rojas Godoy, Gonzalo Andrés; Varela Ubilla, Cristián Nacor; Tapia Vásquez, Juan Carlos; Castillo Fuenzalida, Luis Benito
    Objective: To assess the acute effect of a lung recruitment maneuver (LRM) on lung morphology in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Patients: Ten patients with ALI/ARDS on mechanical ventilation. Design: Prospective clinical study. Setting: Computed tomography (CT) scan facility in a teaching hospital. Interventions: An LRM performed by stepwise increases in positive end-expiratory pressure (PEEP) of up to 30–40 cmH2O. Lung basal CT sections were taken at end-expiration (patients 1 to 5), and at end-expiration and end-inspiration (patients 6 to10). Arterial blood gases and static compliance (Cst) were measured before, during and after the LRM. Measurements and main results: Poorly aerated and non-aerated tissue at PEEP 10 cmH2O accounted for 60.0±29.1% of lung parenchyma, while only 1.1±1.8% was hyperinflated. Increasing PEEP to 20 and 30 cmH2O, compared to PEEP 10 cmH2O, decreased poorly aerated and non-aerated tissue by 16.2±28.0% and 33.4±13.8%, respectively (p<0.05). This was associated with an increase in PaO2 and a decrease in total static compliance. Inspiration increased alveolar recruitment at all PEEP levels. Hyperinflated tissue increased up to 2.9±4.0% with PEEP 30 cmH2O, and to a lesser degree with inspiration. No barotrauma or severe hypotension occurred. Conclusions: Lung recruitment maneuvers improve oxygenation by expanding collapsed alveoli without inducing too much hyperinflation in ALI/ARDS patients. An LRM during the CT scan gives morphologic and functional information that could be useful in setting ventilatory parameters.
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    Prevalencia de sepsis grave en las Unidades de Cuidado Intensivo. Primer estudio nacional multicéntrico
    (2007) Dougnac Labatut, Alberto; Mercado Flores, Marcelo Esteban; Cornejo Rosas, Rodrigo Alfredo; Cariaga Vergara, Mario Alberto; Hernández P., Glenn; Andresen Hernández, Max Alfonso; Bugedo Tarraza, Guillermo; Castillo Fuenzalida, Luis Benito
    Background: Severe sepsis (SS) is the leading cause of death in the Intensive Care Units (ICU). Aim: To study the prevalence of SS in Chilean ICUs. Material and methods: An observational, cross-sectional study using a predesigned written survey was done in all ICUs of Chile on April 21st, 2004. General hospital and ICU data and the number of hospitalized patients in the hospital and in the ICU at the survey day, were recorded. Patients were followed for 28 days. Results: Ninety four percent of ICUs participated in the survey. The ICU occupation index was 66%. Mean age of patients was 57.7+18 years and 59% were male, APACHE II score was 15+7.5 and SOFA score was 6+4. SS was the admission diagnosis of 94 of the 283 patients (33%) and 38 patients presented SS after admission. On the survey day, 112 patients fulfilled SS criteria (40%). APACHE II and SOFA scores were significantly higher in SS patients than in non SS patients. Global case-fatality ratio at 28 days was 15.9% (45/283). Case-fatality ratio in patients with or without SS at the moment of the survey was 26.7% (30/112) and 8.7% (17/171), respectively p <0.05. Thirteen percent of patients who developed SS after admission, died. Case-fatality ratios for patients with SS from Santiago and the other cities were similar, but APACHE II score was significantly higher in patients from Santiago. In SS patients, the independent predictors of mortality were SS as cause of hospital admission, APACHE II and SOFA scores. Ninety nine percent of SS patients had a known sepsis focus (48% respiratory and 30% abdominal). Eighty five patients that presented SS after admission, had a respiratory focus. Conclusions: SS is highly prevalent in Chilean ICUs and represents the leading diagnosis at admission. SS as cause of hospitalization, APA CHE II and SOFA scores were independent predictors of mortality.
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    Síndrome de respuesta inflamatoria sistémica severa: ¿Es comparable a la sepsis severa?
    (1999) Hernández P., Glenn; Dougnac Labatut, Alberto; Castro O, J.; Labarca M, E.; Ojeda M, M.; Bugedo Tarraza, Guillermo; Castillo Fuenzalida, Luis Benito; Andresen Hernández, Max; Bruhn, Alejandro; Huidobro M, L.F.; Huidobro M, R.; Caballero G, M.T.; Hernández M, A.
    Background: In 1992, a consensus conference defined the terms systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock. Since then, numerous reports have validated the prognostic usefulness of these operative definitions. Aim: To evaluate if sepsis severity criteria, as defined by the Consensus Conference, can be applied to noninfectious SIRS. Patients and methods: Five hundred eighteen patients admitted to 5 intensive care units (ICU) from 4 hospitals were prospectively evaluated during a 3 months period. Patients that met at least one severity criteria were included. SIRS etiology, organ dysfunction and evolution were recorded in each patient. Results: One hundred two patients were included: 79 with sepsis (group I) and 23 with noninfectious SIRS (group II). ICU and hospital mortality were comparable (43 and 48% in sepsis compared to 43 and 51% in non infectious SIRS). The most common sources of sepsis were pneumonia and peritonitis. Group II patients had a wide variety of diseases. ICU stay, APACHE score and number of organs with dysfunction were not different among groups. Only the incidence of renal dysfunction was higher in the septic group. Conclusions: The Consensus sepsis severity criteria can be applied to noninfectious SIRS, defining a population subset with similar high mortality and organ dysfunction incidence, although with greatly heterogeneous etiologies.
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    Ventilación diferencial en el manejo del síndrome de distress respiratorio agudo secundario a mediastinitis necrotizante descendente. Rol de la tomografía axial computarizada dinámica de pulmón
    (2003) Bugedo Tarraza, Guillermo; Bruhn, Alejandro; Hernández P., Glenn; Rojas C., Gonzalo; Aparicio Ramírez, Rodrigo Pablo; Castillo Fuenzalida, Luis Benito
    Lung computed tomography (CT) is being used increasingly to assess lung morphology in patients on mechanical ventilation. Lung CT under known levels of airway pressure (dynamic CT) can also assess the response of lung parenchyma to ventilatory therapy. We report a patient with acute respiratory distress syndrome secondary to descending necrotizing mediastinitis, in whom lung dynamic CT oriented ventilatory management. Independent lung ventilation improved gas exchange and helped patient recovery